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PCOS

7 Causes of Infertility

It can be a real challenge to determine the true source of fertility problems. This article does not include endometriosis nor is it all inclusive for the causes of infertility. To be properly diagnosed you need to consult with your medical care provider. However, this article will give you food for thought concerning multiple problems and possible underlying causes and solutions.

Emotional Side Effects

Abdominal Fat Storage

Insulin Resistance

Polycystic Ovarian Syndrome

Miscarriages and Ketosis

Preeclampsia

Gestational Diabetes

Emotional Effects

How many times have you been told, ‘just relax, it will happen’? Stress causes increased cortisol production, which promotes weight gain, which causes insulin resistance, which causes increased insulin in the blood stream, which causes multiple problems with fertility.

Fertility problems rank high on emotional issues. Husbands and wives have broken-up over fertility problems. (Berman PhD, 2014) Families have gone bankrupt over infertility treatment costs. (Berman PhD, 2014) Telling you to relax is much easier said than done. (Berman PhD, 2014)

An underlying problem is that schools don’t teach how to handle stress! People can go through their whole life and never learn how to adequately deal with their stress. They turn to smoking, drinking, drugs (prescription and non-prescription) and other addictions to avoid dealing with stress. Everyone could benefit from instructions on how to manage stress. Unfortunately, it is not as easy as taking a college course. Stress management is individualized.

Some people pray, some people meditate, and some people take long walks in the woods. No one can tell you what will work best for you. You have to do your own discovery work. I have a great post, First-Aid Box for Emotions, which talks about how to be prepared for emotional issues.

Uncontrolled stress can cause fertility problems. It triggers the release of adrenalin to feed your fight or flight mechanism. When you don’t fight or flight (which most of us can’t physically react to stress) then the adrenalin triggers the endocrine (hormone) system to produce cortisol. Cortisol has multiple effects on the body including infertility. Simply put; if you are fighting for your life, then you are not going to get pregnant. Another effect of cortisol is it increases fat storage.

Abdominal Fat Storage

How many times have you been told to lose weight to get pregnant? Abdominal fat can physically interfere with how the egg is delivered. (How can you lose the fat deposited around your ovaries?) Having a body mass index (BMI) over 32 is directly associated with problems of ovulation and conception as well as other challenges during the pregnancy. (Berman PhD, 2014) If you plan to get pregnant it is advisable to lose weight if your BMI is above 24. (BermanPhD, n.d.)

Abdominal fat can also interfere with the many other organs within the body cavity. Fatty liver disease is common with weight challenged individuals. The liver is the largest organ in the body and it has multiple functions. It is affected by the endocrine system. When stress triggers your fight or flight mechanism, the liver releases energy (blood sugar) to enable you to fight for your life or run a marathon. When you don’t use the extra energy, it triggers the pancreas to produce insulin to store the excess energy as fat. Over time, these increased fat stores cause insulin resistance which causes your pancreas to work harder to control your blood sugar.

Insulin Resistance

Insulin resistance and the resulting increased blood insulin are key to many fertility problems. (Insulin resistance means your body loses the ability to use the energy needed in every cell of your body. Your pancreas compensates by producing more insulin.) Thousands of people have insulin resistance and have never been diagnosed. In these women, the required excess insulin also triggers increased levels of testosterone. (Campbell, 2015) The increased testosterone can completely shut down ovulation.

Increased blood insulin can also decrease Follicle Stimulating Hormones (FSH) and Luteinizing Hormones (LH). If ovulation does occur, the quality of the egg produced is reduced which results in difficulties maintaining the pregnancy (i.e. increased miscarriages). (Campbell, 2015) Increased blood insulin also increases the production of androgen from the ovaries. (Nutritionist, 2015) Sixty to eighty-five percent of fertility problems have been identified as having increased androgen or insulin resistance. (Marc A Fritz, 2011) Insulin resistance can be diagnosed using a hemoglobin A1C blood test. Changes in reproductive hormones can be identified with elevated hemoglobin A1C levels. (Nutritionist, 2015)

Additional tests are available but often not covered by insurance. Organic Acid Test (OAT) can measure the carbohydrate metabolism rate. An elevated L-Lactate indicates insulin resistance. (Brar, 2017) Also measuring the bacteria in the gut can indicate problem in digestion. To diagnose preventable diseases before symptoms develop, the standard blood tests are not adequate. Patients need to be proactive with their health care provider by inquiring about other tests to identify preventable diseases.

Polycystic Ovarian Syndrome

Insulin Resistance also promotes Polycystic Ovarian Syndrome (PCOS). Thirty percent of lean women with PCOS and 95% of overweight women with PCOS also have insulin resistance. (Nutritionist, 2015) In PCOS, the eggs are not released from the ovary and they form cysts (abscesses) on the ovaries.

This condition can start as early as puberty and be misdiagnosed as irregular periods. The common practice of placing women on birth-control pills to regulate their periods actually allows this condition to continue untreated. Many women are not diagnosed with PCOS until they are experiencing infertility. If diagnosed and treated early, infertility from PCOS can be prevented. Before the age of 40, 55% of women with PCOS will be diagnosed with type 2 diabetes or prediabetes.

If you want to read more on this topic, I have a post, PCOS and Insulin Resistance, which gives more details on the connection between PCOS, Insulin Resistance, and Infertility.

Miscarriages and Ketosis

An increased risk for miscarriages is associated with insulin resistance and undiagnosed prediabetes or type 2 diabetes. (Alkon, 2017) When your body has difficulty using blood sugars, your body will revert to burning protein and fats for energy. This process produced ketones. (Frise, 2010) As the pregnancy progresses, the woman’s body increases in insulin resistance. (Frise, 2010) The breakdown of fats puts you into a state of ketoacidosis (DKA). Typically, if you go more than ten hours between meals, your body will revert to proteins and fats for an alternative energy source. This can be quickly reversed by eating breakfast.

Today, many people with prediabetes are being encouraged to eat a low carbohydrate/high protein diet to “control” their prediabetes. This can be very dangerous to the developing embryo during early pregnancy. (Williams, 2018) (Frise, 2010) Elevated ketones can cause your body to quickly miscarriage. Ketoacidosis can also contribute to elevated blood pressure.

Preeclampsia

Elevated blood pressure during pregnancy is often defined as preeclampsia (Frise, 2010) It is associated with high protein diets. (CNS, 2017) Diagnosis of preeclampsia results from high protein levels in urine tests. (CNS, 2017) . In developing nations, Eclampsia is the leading cause of maternal-fetus mortality. (CNS, 2017) Fifty-one babies out of 1000 are stillbirths and high blood pressure is a major contributing factor in these births. (CNS, 2017) Insulin resistance coupled with high protein/low carb diets increase the risk for high blood pressure in expecting mothers. Women who are pregnant need to eat a well-balanced diet and get regular exercise and monitor their blood pressure.

Gestational Diabetes

Diabetes during pregnancy is not your fault. During pregnancy, your body produces growth hormones as well as other hormones to promote the pregnancy and the embryo’s growth and development. Around 26 weeks, those hormones start to rapidly increase. (Stoppler MD, 2016) Around 26-28 weeks, your doctor will check for gestational diabetes. Gestational diabetes is totally hormone driven. As the hormone produced during pregnancy increase, so does your chances of developing gestational diabetes. After delivery, gestational diabetes will go away. (Stoppler MD, 2016) Unfortunately, diabetes during pregnancy indicates your body has insulin resistance. (Stoppler MD, 2016) This diagnosis places you at greater risk for developing type 2 diabetes before the age of 40.

Pregnancy can be a beautiful thing. Many people view giving birth as a miracle. It is literally the gift of life. As many women delay pregnancy into their thirties, this also increases the chance of fertility problems and other health issues associated with pregnancy. Unfortunately, pregnancy places a lot of stress on a woman’s body. What happens during pregnancy can be an indicator of other health problems you will face. If you want to learn more about how you can avoid gestational diabetes, check out my post, 8 Tips to Avoid Gestational Diabetes.

My hope is that this article, 7 Causes of Infertility, gives you some ideas of what could be going on and what you can do about it if you’re facing infertility. If you want to learn more about my Gestational Diabetes course, I have a 30-day virtual course that you might be interested in. Follow this link to get more information. If you’re not sure what kind of help or support you need, schedule a discovery call with me and we’ll figure it out together.

Polycystic Ovary Syndrome

By Julie Stelting RN CDE

Girls as young as 12 years old have been diagnosed with polycystic ovarian syndrome (PCOS). But what is the connection between PCOS and insulin resistance?

Many teenage girls are placed on birth control pills to regulate their cycles, improve pain associated with their periods and improve acne. These are all signs of PCOS. Although birth control pills improve the symptoms, they mask this potential problem which can create fertility problems in their future. (Gambineri, 2012) Irregular cycles, period pain, and acne are all signs of PCOS. When diagnosed early, PCOS can be cured and future infertility problems can be avoided. PCOS is increased with abdominal fat. To prevent PCOS, we must consider how abdominal fat effects body chemistry.

What is the PCOS and Insulin Resistance Connection?

The exact cause of PCOS is unknown. PCOS is involved with the endocrine system which is a feedback hormone system that involves the whole body. Since this is involved with the hormones, it is understandable that young girls going through puberty are at higher risk. These hormone changes during puberty also encourages weight gain. Biologically, their body is preparing for a pregnancy. Unfortunately, young girls who are not thin are at risk for gaining too much weight which can result in insulin resistance and contribute to PCOS.

As body mass index (BMI) increases, the incidence of PCOS also increases. Up to 70% of women with PCOS are classified as obese. (Barber & Franks, 2012) When diagnosed early, PCOS frequently resolves with substantial weight loss. (Barber & Franks, 2012) Many people who are trying to lose weight benefit from a support group or an individual coach.

How do you test for PCOS?

Sex Hormone Binding Globulin (SHBG) is a common blood test used to predict PCOS. Increased body fat and insulin resistance decreases the liver’s production of SHBG. (Sex Hormone Binding Globulin and PCOS, n.d.) In fact, the decreasing SHBG levels are being used to identify insulin resistance and prediabetes before the pancreatic beta cells die off and blood sugar levels rise. (Gambineri, 2012) Diabetes can be prevented with early detection before the beta cells die.

Fifty percent of women with PCOS will develop prediabetes or Type 2 diabetes before the age of 40. ((APS), 2015) Increasing weight is associated with insulin resistance and hyperinsulinemia (increased levels of insulin in the blood). (Barber & Franks, 2012) Before blood sugar levels are uncontrollable, the pancreas goes into high production. When the problems associated with insulin resistance are not resolved, the beta cells will die off. This triggers uncontrolled blood sugar which is diagnosed as prediabetes or type 2 diabetes.

How is PCOS and Insulin Resistance related to Fertility Issues?

Insulin resistance in PCOS is well recognized. Up to 90% of women with PCOS are insulin resistant. (Spero, 2016) The presences of high levels of insulin inhibits ovarian folliculogenesis (the development of the follicles). (Willis, Watson, Mason, Brincat, & Franks, 1998) Think of this like fruit with its seeds inside. When the outside of the fruit (follicles) don’t ripen, the seed (or eggs) inside are not released and it forms a cyst. This is easy to see on diagnostic pictures.

Increased levels of insulin not only inhibit folliculogenesis but also stimulates the production of testosterone which suppresses the ovaries. (Spero, 2016) High levels of testosterone is associated with acne. One of the benefits of taking birth control pills is improved acne. Acne can also be caused by bacteria, so it is important to be properly evaluated for this problem.

How is PCOS treated?

Metformin is the first prescription used for PCOS. It is also the first medication used in diabetes management. (Gambineri, 2012) It works to improve the liver functions. The liver synthesizes SHBG as well as helps to regulate blood glucose. (Gambineri, 2012) Real improvements in liver function will result in improved PCOS and blood sugar control. Unfortunately, Metformin has a side effect of GI upset. If it is started at a low (tolerable) dose and increased as tolerated, most of the side effects can be avoided. Many clinicians are starting Metformin at a lower dose than is recommended to improve patient compliance. Metformin also has a time released formula available. Clients need to be encouraged to take this Rx.

Can PCOS be prevented?

There is no known prevention for PCOS. (Clinic, 2017)

Improved lifestyle habits are key to improving PCOS. (Spero, 2016)

Lifestyle changes include:

Reduce refined carbohydrates

Increase dietary fiber

Regular exercise

Eating for your body’s limitations with small frequent meals

Reduce processed foods

Eliminate alcohol, smoking and caffeine

Be evaluated for individual needs of supplemental vitamin D and chromium

It is far better to understand the causes of your teen’s problems than it is to simply mask the symptoms. Placing teens on birth control pills to control the symptoms can cause significant fertility problems in their future by masking the signs of PCOS.